Provider Demographics
NPI:1275055865
Name:CHAMPION, JENNIFER LORENE (DNC, MS,CNS, CN, DCN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:LORENE
Last Name:CHAMPION
Suffix:
Gender:F
Credentials:DNC, MS,CNS, CN, DCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7018 59TH STREET CT W
Mailing Address - Street 2:
Mailing Address - City:UNIVERSITY PLACE
Mailing Address - State:WA
Mailing Address - Zip Code:98467-2172
Mailing Address - Country:US
Mailing Address - Phone:253-507-5775
Mailing Address - Fax:
Practice Address - Street 1:7018 59TH STREET CT W
Practice Address - Street 2:
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-2172
Practice Address - Country:US
Practice Address - Phone:253-507-5775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-14
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANU60733491133N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133N00000XDietary & Nutritional Service ProvidersNutritionistGroup - Single Specialty